Articles: back-pain.
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Randomized Controlled Trial Multicenter Study
Botulinum type A toxin complex for the relief of upper back myofascial pain syndrome: how do fixed-location injections compare with trigger point-focused injections?
This was a prospective, randomized, double-blind, placebo-controlled, 12-week, multicenter study to evaluate the efficacy and tolerability of fixed location injections of botulinum type A toxin (BoNT-A, Dysport) in predetermined injection sites in patients with myofascial pain syndrome of the upper back. ⋯ Fixed-location treatment with BoNT-A of patients with upper back myofascial pain syndrome did not lead to a significant improvement of the main target parameter in week 5 after treatment. Only in week 8 were significant differences found. Several secondary parameters, such as physicians' global assessment and patients' global assessment, significantly favored BoNT-A over placebo at weeks 8 and 12.
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An 80-year-old female with a history of osteoporosis was evaluated for sudden onset axial low back pain with bilateral lower extremity weakness, hyperreflexia, pain, urinary retention, and decreased rectal tone. Computed tomography of the lumbar spine revealed L1 compression fracture, retropulsion of bone causing spinal canal compromise with associated severe central canal stenosis. ⋯ Chest radiograph and computed tomographic pulmonary angiogram revealed a large collection of hyperdense material within the right lower lobe pulmonary artery, consistent with pulmonary cement emboli. Management and imaging are discussed.
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Opioid prescribing for noncancer pain has increased dramatically. We examined whether the prevalence of unhealthy lifestyles, psychologic distress, health care utilization, and co-prescribing of sedative-hypnotics increased with increasing duration of prescription opioid use. ⋯ Prescription of opioids was common among patients with back pain. The prevalence of psychologic distress, unhealthy lifestyles, and health care utilization increased incrementally with duration of use. Coprescribing sedative-hypnotics was common. These data may help in predicting long-term opioid use and improving the safety of opioid prescribing.
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The aim of the study was to evaluate the impact of pregnancy-related back pain on quality of life and physical ability in the third trimester of pregnancy. One hundred women in the 28th-40th week of pregnancy were asked to fill out questionnaires including: general questions about background factors, the Katz's Activity's Daily Living Index (ADL), and Short Form of WHO Quality of Life Questionnaire (WHOQOL-BREF). ⋯ It was found that, in the third trimester, pregnant women with back pain (PBP) with low pain intensity and moderate functional limitation did not have an impact on quality of life but decreased physical ability when compared to pregnant women with no back pain (NBP). As the back pain intensity of pregnant women increases, physical ability decreases.
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Comparative Study
Quantitative sensory testing profiles in chronic back pain are distinct from those in fibromyalgia.
Alterations in the central nervous system leading to higher pain sensitivity have been shown in both chronic back pain (CBP) and fibromyalgia syndrome (FMS). The aim of this study was to disclose commonalities and differences in the pathophysiology of FMS and CBP. ⋯ FMS patients showed increased sensitivity for different pain modalities at all measured body areas, suggesting central disinhibition as a potential mechanism. CBP participants in contrast, showed localized alterations within the affected segment possibly due to peripheral sensitization.